Volume 4, Issue 15
April 14, 2011

What not to do if you
have breast cancer

A breast cancer diagnosis is one of the most stressful things that can happen to any woman. The disease itself is stressful enough. But then they have to make so many decisions about treatment options. And one of the most stressful is “Should I have surgery?” And if so, “What kind of surgery?” Well, a new study may make this decision a lot easier.

Often, when a woman has breast cancer, she has to undergo surgery. But the question then becomes how extensive should the surgery be? For many surgeons, the answer is very extensive. Breast cancers frequently spread to the lymph nodes under the arm. We call these the axillary nodes. So in an attempt to “get it all” many surgeons not only take out the breast cancer itself, but also remove all of the lymph nodes “just in case.”  They call this complete removal process an axillary lymph node dissection (ALND).

But lymph nodes are there for a reason. They help to prevent the further spread of cancer. They are also an important way to protect the arm from infections. So when you remove them, you place the patient at risk. But that’s not the only problem with an ALND.

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The arm, like every other part of the body, constantly makes lymph fluid. The lymph fluid from the arm drains through the axillary nodes. So when you remove them, you automatically block the pathways through which the lymph fluid drains. This has two effects. One, the arm becomes swollen, often to twice its size. Two, the failure for the lymph system to work properly puts the arm and hand at a much greater risk of infection.

Fortunately, ALND is not the only option surgeons have. The other option is the SLND.

SLND stands for sentinel lymph node dissection. And it is much more benign than ALND.  That’s because using this technique, it is possible to determine which lymph nodes are the ones most likely to contain cancer. And then the surgeon removes only those “at risk” nodes. The rest of the lymph system remains in place. So there are none of the side effects I mentioned above.

Despite this advancement in treatment, many surgeons still recommend ALND. But this new study is going to change all that.

The study looked at 1,900 women with a recent diagnosis of breast cancer. All of the women had a lumpectomy, a simple removal of the tumor while leaving the rest of the breast intact. Then they had radiation therapy. After the radiation, surgeons performed an ALND on half of them and an SLND on the other half.

They followed these women for an average of 6.3 years. The five-year survival rate for the ALND group was 91.8%. The rate for SLND group was 92.5%. In terms of the cancer recurrence rate, 17.8% of the ALND group experienced a return of their cancer. That’s compared to 16.7% for the SLND group.

From a statistical perspective there was no difference at all in the outcomes for these women. It didn’t matter whether they had the more invasive ALND or an SNLD.  These results clearly show that there is no advantage to cutting out more lymph nodes. So if you or a loved one has breast cancer and it requires surgery, make sure your surgeon sees this article. It could give you a much better outcome.

I treat a lot of patients with cancer and not all of them require surgery. If you’d like to learn more about how I approach cancer treatment, you can watch my cancer video on the clinic website at www.antiagingmedicine.com.

Finding your Real Cures,

Frank Shallenberger, MD

REF: Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011 Feb 9;305(6):569-75.


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